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Immediate administration of antiviral therapy after transplantation of hepatitis C‐infected livers into uninfected recipients: Implications for therapeutic planning
Author(s) -
Bethea Emily,
Arvind Ashwini,
Gustafson Jenna,
Andersson Karin,
Pratt Daniel,
Bhan Irun,
Thiim Michael,
Corey Kathleen,
Bloom Patricia,
Markmann Jim,
Yeh Heidi,
Elias Nahel,
Kimura Shoko,
Dageforde Leigh Anne,
Cuenca Alex,
Kawai Tatsuo,
Safa Kassem,
Williams Winfred,
Gilligan Hannah,
Sise Meghan,
Fishman Jay,
Kotton Camille,
Kim Arthur,
Rogers Christin C.,
Shao Sarah,
Cote Mariesa,
Irwin Linda,
Myoung Paul,
Chung Raymond T.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15768
Subject(s) - medicine , hepatitis c , transplantation , liver transplantation , hepatitis c virus , immunology , virus
The practice of transplanting hepatitis C (HCV)‐infected livers into HCV‐uninfected recipients has not previously been recommended in transplant guidelines, in part because of concerns over uncontrolled HCV infection of the allograft. Direct‐acting antivirals (DAAs) provide an opportunity to treat donor‐derived HCV‐infection and should be administered early in the posttransplant period. However, evidence on the safety and efficacy of an immediate DAA treatment approach, including how to manage logistical barriers surrounding timely DAA procurement, are required prior to broader use of HCV‐positive donor organs. We report the results of a trial in which 14 HCV‐negative patients underwent successful liver transplantation from HCV‐positive donors. Nine patients received viremic (nucleic acid testing [NAT]‐positive) livers and started a 12‐week course of oral glecaprevir‐pibrentasvir within 5 days of transplant. Five patients received livers from HCV antibody‐positive nonviremic donors and were followed using a reactive approach. Survival in NAT‐positive recipients is 100% at a median follow‐up of 46 weeks. An immediate treatment approach for HCV NAT‐positive liver transplantation into uninfected recipients is safe and efficacious. Securing payer approval for DAAs early in the posttransplant course could enable need‐based allocation of HCV‐positive donor organs irrespective of candidate HCV status, while averting chronic HCV allograft infection.